Women diagnosed with heptocellular cancer in louisiana have higher rates of treatment and better survival compared to men

Abstract

Presenter: Andrea Fa MD | Louisiana State University Health Science Center Background: Hepatocellular cancer (HCC) is a male-dominated disease, and clinicopathologic characteristics of women with HCC remain poorly defined. Louisiana ranks 5th in HCC incidence and 2nd in HCC mortality in the United States. We sought to better understand gender differences amongst HCC patients in Louisiana - one of the highest incidence and mortality states in the nation. Methods: HCC patients diagnosed in Louisiana between 2005 and 2015 were identified from the Louisiana Tumor Registry (LTR) using ICD-3-O primary site code 220 and histology codes 8170-8180. We excluded cases diagnosed by death certificate/autopsy and those for which HCC was not the patient’s first tumor. Incidence, demographics, treatment, and outcomes were compared between men and women. Patient clinicopathologic characteristics were compared using two-sample t-tests and chi-square tests. HCC-specific survival was analyzed via Cox proportional hazard models. Results: 2,627 patients were included in the analysis, 498 (19%) were women. During the study period, age-adjusted incidence of HCC was 15.8 per 100,000 men and 3.5 per 100,000 women . Women were older (65.1 vs. 61.3, p < 0.0001), but were more often diagnosed with early stage disease (AJCC I or II) (p = 0.0224) than men. The severity of comorbidities was not different between women and men (p = 0.1277). Women were more likely to have received liver-directed surgery (LDS) (27.5% vs. 22%, p = 0.009). Women had improved survival when compared to men (HR (95% CI): 1.15 (1.02,1.29)), after adjusting for stage, age, race, comorbidity score, and treatment location. This survival difference was no longer significant after controlling for LDS (HR (95% CI): 1.09 (0.97,1.22)). Multivariable factors associated with worse survival in women were advanced stage (p < 0.0001), treatment location (p < 0.0001) and no LDS (p < 0.0001). There was no affect on survival in women due to race or age as there was in men (See Table 1). Conclusion: There are significant clinicopathologic differences between the men and women with HCC. Women are diagnosed at an earlier stage, they have a greater likelihood of having LDS, and they have improved survival compared to men. These data can be used to direct public health resources to the most at-risk groups.